Lymphangioma of the scrotum


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Resumo

Introduction. Lymphangioma (lymphatic malformation) is a congenital malformation of lymphatic vessels. According to the classification of the International Society for the Study of the Vascular Anomalies, there are macrocystic, microcystic and mixed types of lymphatic malformations. The typical location of the lymphangiomas is the area of large lymphatic collectors (head, neck, axillary areas), while the scrotum is not frequently affected.

Aim. To present a rare clinical case of lymphatic malformation of the scrotum with successful minimally invasive treatment (sclerotherapy).

Materials and methods. A clinical observation of a 12-year-old child with a diagnosis of «Lymphatic malformation of the scrotum» is presented. From the age of 4, there was a large lesion in the left half of the scrotum. In other clinic, a surgical removal with a diagnosis of «left-sided inguinal hernia», «spermatic cord hydrocele», «isolated left-sided hydrocele» was performed. However, there was a recurrence after the procedure. When contacting the Clinic of pediatrics and pediatric surgery, scrotal lymphangioma was suspected. The diagnosis was confirmed by magnetic resonance imaging. The patient underwent minimally invasive sclerotherapy using the drug «Haemoblock». After 6 months of follow-up, no relapse was seen.

Conclusion. Lymphangioma (lymphatic malformation) of the scrotum is a rare urological pathology that requires specific diagnosis, in-depth differential diagnosis and treatment by a multidisciplinary team of doctors, including a specialist in the treatment of vascular pathology.

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Sobre autores

D. Safin

Professional Medical Center, Clinic of Pediatrics and Pediatric Surgery

Autor responsável pela correspondência
Email: safindinar@ya.ru
ORCID ID: 0000-0001-9436-3352
Código SPIN: 7879-7829

chief

Rússia, Moscow

D. Tarusin

Professional Medical Center, Clinic of Pediatrics and Pediatric Surgery

Email: tarusindi@yandex.ru

Corresponding member of the Russian Academy of Natural Sciences, Professor, Ph.D., MD, urologist of the highest category, pediatric urologist-andorologist

Rússia, Moscow

A. Matar

Professional Medical Center, Clinic of Pediatrics and Pediatric Surgery

Email: androlog@bk.ru

professor, Director, pediatric urologist, Head

Rússia, Moscow

Bibliografia

  1. Padia R., Bly R., Bull C, Geddis A.E., Perkins J. Medical Management of Vascular Anomalies. Curr. Treat. Options. Pediatr. 2018;4(2):221–236. doi: 10.1007/s40746-018-0130-3.
  2. Johnson A.B., Richter G.T. Vascular Anomalies. Clin. Perinatol. 2018;45(4):737–749. doi: 10.1016/j.clp.2018.07.010.
  3. Sun R.W., Tuchin V.V., Zharov V.P., Galanzha E.I., Richter G.T. Current status, pitfalls and future directions in the diagnosis and therapy of lymphatic malformation. J. Biophotonics. 2018;11(8):e201700124. doi: 10.1002/jbio.201700124.
  4. Wohlgemuth W.A., Brill R., Dendl L.M., Stangl F., Stoevesandt D., Schreyer A.G. Abdominal lymphatic malformations. Radiologe. 2018;58(Suppl 1):29–33. doi: 10.1007/s00117-017-0337-5.
  5. Okulov A.B., Volodko E.A., Godlevsky D.N., Povarnin O.Ya., Anikiev A.V., Burkin A.G., Sokolov Yu.Yu. A clinical case of giant scrotal abdominal hydrocele in a child of 8 months. «Pediatrics» Journal named after G.N. Speransky, 2018;97(5):201–204.
  6. Kamble P.M., Deshpande A.A., Thapar V.B., Das K. Large abdominoscrotal hydrocele: Uncommon surgical entity. Int. J. Surg. Case Rep. 2015;15:140–42.doi: 10.1016/j.ijscr.2015.08.027.
  7. Mashkov A.E., Slesarev V.V., Druzyuk E.Z. Abdominoscrotal hydrocele in an infant. Pediatric surgery. 2019;23(4):218–219.
  8. Safin D.A., Romanov D.V. The use of the drug «Hemoblock» in the sclerosis of vascular malformations. «Pediatrics» Journal named after G.N. Speransky. 2019;98(6):74–78.
  9. Sereda A.P., Andrianova M.A. Recommendations for the design of the study. Traumatology and orthopedics of Russia. 2019;25(3).

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2. Fig.1. Appearance of the patient's scrotum before surgery for a cyst of the spermatic cord. The scrotum is intact, the folds are clearly visible, the testicles are visualized

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3. Fig.2. Postoperative ultrasound of the left half of the patient's scrotum. A cellular formation that does not contain vessels is visualized

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4. Fig.3. MRI of the pelvis in T2 mode: in the frontal plane (Fig. 3a), in the sagittal plane (Fig. 3b), in the horizontal plane (Fig. 3c). In the left half of the scrotum, a multi-lane formation with liquid contents is determined, the size of the formation is 89x41 mm, the height is up to 70 mm. After contrast enhancement, the accumulation of the contrast agent was not detected. The left testicle is displaced laterally and upward

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5. Fig.4. Ultrasound picture of cavity filling with Hemoblock solution, particles suspended in the solution are visible

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6. Fig.5. Outcome of treatment. The final picture - the appearance of the patient's scrotum after treatment - volumetric formations in the patient's scrotum have decreased

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